A comparison of household lead exposure assessment methods in an old, urban community

The accurate assessment of lead hazards within the household is critical to the prevention of lead exposure to children living in urban communities. Although dust wipes are currently accepted as the best method of assessing lead hazards, questionnaires and visual inspections are also used. This study evaluates the level of agreement among these three methods of assessment using a sample of 126 women living in old, urban houses. The level of agreement was assessed using the kappa statistic, which adjusts for chance agreement. Overall, the kappa results for both the participant's assessment (questionnaire) and the visual inspector's assessment were low, indicating only slight to moderate agreement with the dust lead wipe levels. Kappas were higher and more consistent for the visual inspector's assessment than for the participant's assessment. These results indicate that visual inspections and participant questionnaires may provide less accurate information regarding lead hazards within the household than dust wipes. Because lead hazard recognition is important in the prevention of lead exposure in children, our data suggest that emphasis should be placed on the measurement of dust lead levels directly in assessing household lead hazards, possibly by teaching women in high-risk neighborhoods to take dust samples themselves.